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Developing an Advanced Alternative Payment Model for Stress Urinary Incontinence
Historically, our health care system has been based on a fee-for-service model, which has resulted in high-cost and fragmented care. The Center for Medicare & Medicaid Services is moving toward a paradigm in which health care providers are incentivized to provide cost-effective, coordinated, value-based care in an effort to control costs and ensure high-quality care for all patients. In 2015, the Medicare Access and Children’s Health Insurance Program Reauthorization Act repealed the Sustainable Growth Rate and the fee-for-service model, replacing them with a 2-track system: Merit-based Incentive Payment System and the a...
Source: Female Pelvic Medicine and Reconstructive Surgery - March 31, 2021 Category: OBGYN Tags: AUGS Publications Source Type: research

Postoperative Pain and Urinary Retention After Vaginal Reconstructive Surgery
The objective of this study was to evaluate the effect of patients’ immediate prevoiding pain level after vaginal pelvic reconstructive surgery on their ability to void. Methods We conducted a retrospective cohort study of women with and without urinary retention after urogynecologic procedures. Postoperative pain, measured by a visual analog scale, was recorded for each patient before a voiding trial. Demographic, surgical characteristics, prevoiding trial pain, and rate of postoperative urinary retention were compared. Multiple-logistic regression analysis was used with all analyses controlled for univariate var...
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

The Risk of Primary Uterine and Cervical Cancer After Hysteropexy
Objective The aim of the study was to determine the rate of subsequent uterine/cervical cancer after hysteropexy compared with hysterectomy with apical prolapse repair. Methods The study used a retrospective cohort of women with uterovaginal prolapse using the Cerner Health Facts database between 2010 and 2018. We identified sacrospinous or uterosacral ligament suspensions or sacral colpopexy/hysteropexy and excluded those with previous hysterectomy. We used the International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes for endometrial cancer/hyper...
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

Vaginal Estrogen as First-Line Therapy for Recurrent Urinary Tract Infections in Postmenopausal Women and Risk Factors for Needing Additional Therapy
Conclusions Sixty-eight percent of postmenopausal women with rUTIs treated with vaginal estrogen alone did not go on to receive additional therapy. A risk factor for needing additional therapy in our study population is the presence of urinary incontinence. (Source: Female Pelvic Medicine and Reconstructive Surgery)
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

Autologous Fascia Lata for Combined Sacrocolpopexy and Rectopexy
We present a case series and video of our technique using autologous fascia lata for combined sacrocolpopexy and rectopexy, with or without resection. (Source: Female Pelvic Medicine and Reconstructive Surgery)
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

Rates of Pessary Self-Care and the Characteristics of Patients Who Perform it
This study is a retrospective chart review conducted at a tertiary care center. Demographic data; details regarding pessary use; body weight; pelvic organ prolapse stage; and medical, surgical, and obstetrical histories were evaluated. Variables were compared between groups of patients using the t test, Wilcoxon rank sum test, χ2 test, and Fisher exact test. Results The rate of patients choosing to perform pessary self-care was 31%. The patients in the self-care group were significantly younger (65.0 vs 75.0 years, P (Source: Female Pelvic Medicine and Reconstructive Surgery)
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

Utilization of a Mirror During Pelvic Examinations: Does it Improve the Patient’s Experience?
Conclusions Patients who chose to use the mirror did not demonstrate a difference in pain or vulnerability scores; however, they exhibited benefit to their sense of control and knowledge after the pelvic examination. Although the mirror did not benefit all patients, this is a simple option that could improve the examination experience for some. Clinical Trial Registration:ClinicalTrials.gov, NCT03785548 (Source: Female Pelvic Medicine and Reconstructive Surgery)
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

Twice-Daily Nitrofurantoin Administration Following Short-term Transurethral Catheterization After Pelvic Reconstructive Surgery: A Randomized Clinical Trial
Conclusions Nitrofurantoin prophylaxis after transurethral catheter removal did not reduce the risk of UTI in women with acute POUR after pelvic reconstructive surgery. (Source: Female Pelvic Medicine and Reconstructive Surgery)
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

Impact of Repeat Dosing and Mesh Exposure Chronicity on Exosome-Induced Vaginal Tissue Regeneration in a Porcine Mesh Exposure Model
Objective The aim of the study was to compare vaginal wound healing after exosome injection in a porcine mesh exposure model with (1) single versus multiple dose regimens and (2) acute versus subacute exposure. Methods Six 80-kg Yorkshire-crossed swine each had 2 polypropylene meshes implanted to create the vaginal mesh exposure model. Animals were divided into 3 groups based on number and timing of exosome injection: (1) single purified exosome product (PEP) injection (acute-single), (2) weekly PEP injections (acute-weekly, 4 total injections), and (3) delayed single injection (subacute-single). Acute and subac...
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

Review of Malpractice Litigations Involving Vesicovaginal and Rectovaginal Fistulas Following Elective Hysterectomy for Benign Indications in the United States From 1970 to 2020
Conclusions Thorough documentation, informed consent, and prompt referral to specialists strengthened the defendants’ legal arguments. Intraoperative cystoscopy may also be beneficial. (Source: Female Pelvic Medicine and Reconstructive Surgery)
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

Changes in Morphology of the Urethral Rhabdosphincter Postpartum
Conclusions There is a decrease in urethral rhabdosphincter CSA with worsening Urinary Distress Inventory scores from prepregnancy to postpartum, but these two do not correlate in this cohort with low symptom levels. Among women who give birth vaginally, decrease in rhabdosphincter CSA is correlated with increasing fetal weight, perhaps with ramifications to be seen later in life. (Source: Female Pelvic Medicine and Reconstructive Surgery)
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

Preoperative Counseling Method and Postoperative Opioid Usage: A Secondary Analysis of the PREOP Study
Conclusions Despite similar pain scores, women who received preoperative phone counseling before pelvic organ prolapse surgery had lower opioid utilization than those with office counseling. Further research is needed to determine the optimal method of preoperative counseling and its role in postoperative pain management. (Source: Female Pelvic Medicine and Reconstructive Surgery)
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

The Influence of Patients’ Goals on Surgical Satisfaction
Conclusions Ninety-one percent of women achieved their presurgical goals, the most common being symptom relief. Goal achievers have higher satisfaction and less regret; however, those with worsening or de novo urinary symptoms are more likely to be GNAs and be unsatisfied. (Source: Female Pelvic Medicine and Reconstructive Surgery)
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

Perceptions of Mesh Use for Pelvic Floor Surgery in Latinas: Face Validity of a Spanish Questionnaire
Conclusions This study demonstrated face validity of a Spanish-translated survey assessing perceptions of mesh use in pelvic surgery in a Latina population. Participants’ feedback was crucial to optimizing the quality of the survey for future studies that will evaluate Spanish-speaking patients’ views of mesh implants in pelvic reconstructive surgery. (Source: Female Pelvic Medicine and Reconstructive Surgery)
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research

Association Between Hemoglobin A1c and Midurethral Sling Complications in Diabetic Women: A Cohort Study
Objective We aimed to evaluate the association between hemoglobin A1c (HbA1c) levels and midurethral sling (MUS) complications. Methods This was a multihospital, retrospective cohort study from 2010 to 2020. We included all women with diabetes mellitus who underwent a synthetic mesh MUS procedure and had a preoperative HbA1c within 3 months of surgery. The primary outcome was a composite of complications, including MUS mesh exposure, surgical site granulation tissue or infection, urinary tract infection, surgical site pain beyond 6 weeks postoperatively, and MUS failure. A sensitivity analysis analyzing MUS fail...
Source: Female Pelvic Medicine and Reconstructive Surgery - February 23, 2021 Category: OBGYN Tags: AUGS Special Issue Submission Source Type: research